Bottom Line:
Median DFS was 19.2 months.Survival was superior in the Whipple procedure group than in the total pancreatectomy group (median survival 19 months vs 4 months, respectively).Vascular resection and retroperitoneal safety margin status did not affect disease relapse.

Introduction: Pancreatic carcinoma affecting the uncinate process is a challenging surgical condition. Several considerations affect the management plan, including the need for vascular resection and the ability to achieve a clear margin.

Methods: The data of 19 patients who had curative resection for pancreatic adenocarcinoma of the uncinate process were reviewed. Operative mortality and morbidity, and disease-free survival (DFS) were calculated.

Results: The study population included 13 male and 6 female patients with a mean age of 55 years. Nine patients (47.4%) had stage I disease, seven patients (36.8%) had stage II disease, and three patients (15.8%) had stage III disease. A total of 12 patients had Whipple procedure and 7 patients had total pancreatectomy. In total, there were 9 R0 and 10 R1 resections. Operative mortality rate was 10.5% (2/19), postoperative leakage rate was 21.1% (4/19), and wound sepsis rate was 21.1%. Median DFS was 19.2 months. Survival was superior in the Whipple procedure group than in the total pancreatectomy group (median survival 19 months vs 4 months, respectively). Vascular resection and retroperitoneal safety margin status did not affect disease relapse.

Mentions:
All patients were followed for the occurrence of relapse. Median DFS for the whole group was 19.2 months (95% CI = 11.2–27.3 months). On univariate analysis, the type of resection (Whipple vs. total pancreatectomy), infiltration of the retroperitoneal safety margin, and the presence of vascular resection did not affect the relapse rate (all P-values = NS; chi-square test). Patients who received total pancreaticoduodenectomy had shorter DFS than patients who underwent Whipple resection. The presence of vascular resection did not affect DFS in this cohort (Figs. 1 and 2). Similarly, 12 patients with free retroperitoneal margin and 7 patients with infiltrated margin had no significant difference in median DFS (19.22 vs. 17.87 months; P = NS; log-rank, Mantel–Cox tests). Only three patients had an infiltrated pancreatic transaction margin and one patient had a narrow transaction margin. Three other patients were offered vascular resection, and their data are summarized below.

Mentions:
All patients were followed for the occurrence of relapse. Median DFS for the whole group was 19.2 months (95% CI = 11.2–27.3 months). On univariate analysis, the type of resection (Whipple vs. total pancreatectomy), infiltration of the retroperitoneal safety margin, and the presence of vascular resection did not affect the relapse rate (all P-values = NS; chi-square test). Patients who received total pancreaticoduodenectomy had shorter DFS than patients who underwent Whipple resection. The presence of vascular resection did not affect DFS in this cohort (Figs. 1 and 2). Similarly, 12 patients with free retroperitoneal margin and 7 patients with infiltrated margin had no significant difference in median DFS (19.22 vs. 17.87 months; P = NS; log-rank, Mantel–Cox tests). Only three patients had an infiltrated pancreatic transaction margin and one patient had a narrow transaction margin. Three other patients were offered vascular resection, and their data are summarized below.

Bottom Line:
Median DFS was 19.2 months.Survival was superior in the Whipple procedure group than in the total pancreatectomy group (median survival 19 months vs 4 months, respectively).Vascular resection and retroperitoneal safety margin status did not affect disease relapse.

Introduction: Pancreatic carcinoma affecting the uncinate process is a challenging surgical condition. Several considerations affect the management plan, including the need for vascular resection and the ability to achieve a clear margin.

Methods: The data of 19 patients who had curative resection for pancreatic adenocarcinoma of the uncinate process were reviewed. Operative mortality and morbidity, and disease-free survival (DFS) were calculated.

Results: The study population included 13 male and 6 female patients with a mean age of 55 years. Nine patients (47.4%) had stage I disease, seven patients (36.8%) had stage II disease, and three patients (15.8%) had stage III disease. A total of 12 patients had Whipple procedure and 7 patients had total pancreatectomy. In total, there were 9 R0 and 10 R1 resections. Operative mortality rate was 10.5% (2/19), postoperative leakage rate was 21.1% (4/19), and wound sepsis rate was 21.1%. Median DFS was 19.2 months. Survival was superior in the Whipple procedure group than in the total pancreatectomy group (median survival 19 months vs 4 months, respectively). Vascular resection and retroperitoneal safety margin status did not affect disease relapse.